[Clinical manifestations in patients exposed to an environmental toxic accident (Abidjan, Ivory Coast 2006)]. / Manifestations cliniques chez les sujets exposés à un accident toxique environnemental (Abidjan, Côte d'Ivoire 2006).

INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.

[Tympanoplasty: Experience of the ENT department in Yopougon hospital (Ivory Cost)]. / La tympanoplastie: expérience du service ORL du CHU de Yopougon (Côte d'Ivoire).

PURPOSE: Perform an analysis of epidemiological, diagnostic and therapeutic aspects of tympanoplasty in Ivory Coast. MATERIALS AND METHODS: Retro and prospective study over 13 years conducted in the ENT department of Yopougon Teaching Hospital. Our study concerned 104 patients. RESULTS: The study population was dominated by young adults with an average age of 30.61 years. Chronic otitis media accounted for 80.76% of past medical history, a condition that was also the main indication (74.04%). Otoscopy pre- and intraoperative found essentially a non-marginal tympanic perforation (74.03%) and preoperative hearing assessment noted a conductive hearing loss in 72% of cases. The retroauricular surgical incision was performed in all patients. Surgical treatment consisted of a tympanoplasty type I in 76.3% of cases. The anatomical results were good in 81% of cases and functionally, 75% of our patients had interaural intensity difference of less than 20 decibels. CONCLUSION: The tympanoplasty performed in our hospital apparently gives results that are similar to those of western countries to the patients who got a post operative control.

Retrospective study of the rhinoscleroma about 14 cases in ENT departments of university hospitals (Côte d'Ivoire).

PURPOSE OF STUDY: To report the epidemiological, clinical, therapeutic and evolutionary aspects of rhinoscleroma in ENT departments of university hospitals (Côte d'Ivoire). MATERIAL AND METHOD: Retrospective study of rhinoscleroma conducted in the ENT and head and neck surgery departments in Côte d'Ivoire from January 1980 to December 2008 including the cases of confirmed rhinoscleroma and the treated cases. RESULTS: Fourteen cases of rhinoscleroma were found in 28 years. The early manifestations were not specific enough so the patients were seen with clinical status with obvious disorders or physical discomfort. Treatment was medical and surgical. Medical therapy was based on streptomycin, thiopenicol or ciprofloxacin administration. Surgery consisted in removing the fibrous adhesions to correct the functional and aesthetic disorders. CONCLUSION: Rhinoscleroma has become a more and more rare disease because of the sensitivity to the new molecules. Diagnosis can be difficult and delayed because of its clinical polymorphism.

[Evaluation of first void urine in the detection of Neisseria gonorrhoeae in patients less symptomatic in Abidjan (Côte d'Ivoire)]. / Evaluation du premier jet d'urine dans la détection de Neisseria gonorrhoeae chez des patients paucisymptomatiques à Abdidjan (Côte d'Ivoire).

Various diagnostic methods have been described to detect Neisseria gonorrhoeae. Collection of first void urine is advantageous because it is non-invasive, reproducible, and painless; and provides specimens that have already been used for detection of N. gonorrhoeae by molecular tools. The purpose of this study was to assess the usefulness of first void urine for detection of N. gonorrhoeae using conventional bacteriologic techniques in patients with low-grade symptoms. Investigation was focused on first void urine and urethral secretion specimens collected from 87 male patients who were undergoing diagnotic workup for suspicion of sexually transmitted infection. Direct microscopic examination of smears stained using the Gram technique and cultures on modified Thayer-Martin medium and on cooked blood agar were performed on each specimen. The prevalence of urethritis was 58.0%. Gonorrhoea was diagnosed in 7.5% of cases. The sensitivity and specificity of microscopic examination of first void urine for detection of Gram-negative diplococci were 85.7% and 97.5% respectively. First void urine was less productive than urethral secretion for detection of urethritis: sensitivity, 44.4% and specificity, 100%, and urethral flora: sensitivity, 59% and specificity of 96.9%. The good performance of first void urine specimens for detection of Gram-negative diplococci by microscopy may justify their use for identification of N. gonorrhoeae in level 1 laboratories. First void urine could also be useful for epidemiological studies and large-scale screening surveys.

[Cephalometric characteristics of black African children 3-6 years of age with nasal obstruction]. / Caractéristiques céphalométriques chez l'enfant mélano-africain âgé de 3 à 6 ans avec obstruction du cavum.

OBJECTIVE: To determine the cephalometric craniofacial characteristic of the child with chronic rhinopharyngeal obstruction. MATERIAL AND METHODS: It is about a comparative cross-sectional study with etiologic aiming including children of the 2 sexes, old from 3 to 6 years. The pathological subjects are represented by those presenting a chronic rhinopharyngeal obstruction due to the presence of hypertrophied tonsils (n = 29) and the "normal" subjects, those without any rhinopharyngeal obstruction (n = 30). Lateral cephalometric radiographs were obtained for each subject. The conventional landmarks were determined with the subject's head in neutral position. The two groups underwent cephalometric measurements. The cephalometric analysis was made starting from conventional landmarks resulting from soft tissues and osseous structures. Various statistical tests (test t of student, test of Kruskal Wallis, test of Mann-Whitney) were used for the exploitation of the cephalometric data. RESULTS: On the skeletal level, the length of the posterior cranial base was shorter at the pathological subjects than at the healthy subjects. Concerning the mandible, the height of the ramus and the length of the mandibular corpus are also weaker at the pathological subjects than at the witnesses. The hyoid bone is further away from the 3rd cervical vertebra and the craniocervical angle is more open at the pathological subjects, representing a modification of the slope of the cervical column. On the level of the rhinopharyngeal space, the average distances from the posterior nasal spine at the posterior edge of the rhinopharyngeal space and between the posterior nasal spine and the posterior base of the base of cranium are respectively of 19,43 +/- 4,78 mm and 37,56 +/- 2,95 mm. These measurements are not significantly different from those described in the literature. CONCLUSION: Our study highlighted skeletal modifications in children presenting a rhinopharyngeal obstruction. Even if they do not justify all the symptoms met, these modifications can represent a readjustment of the pharyngeal corridor aiming at facilitating the flow of airflow.

Evaluation du premier jet d'urine dans la detection de Neisseria gonorrhoeae chez des patients paucisymptomatiques a Abdidjan (Cote d'Ivoire)

Il existe differentes methodes de diagnostic sur differents types de prelevement pour mettre en evidence Neisseria gonorrhoeae. Le prelevement de premier jet d'urine presente l'avantage d'etre non invasif; facilement reproductible et est deja utilise dans la detection de N. gonorrhoeae par des techniques moleculaires. L'objectif de cette etude etait d'evaluer le premier jet d'urine dans la detection de N. gonorrhoeae par les methodes classiques de bacteriologie chez des patients paucisymptomatiques. Elle a porte sur les prelevements de premier jet d'urine et de secretions uretrales de 87 patients de sexemasculin recus pour le diagnostic etiologique d'un syndrome d'infections sexuellement transmissibles. Un examen direct du frottis colore par la technique de Gram et des cultures sur le milieu de Thayer et Martin modifie et sur gelose au sang cuit enrichie en polyvitamines ont ete realises sur chacun des echantillons. La frequence des uretrites etait de 58;0. La gonococcie representait 7;5des cas. Le premier jet d'urines avait une sensibilite de 85;7et une specificite de 97;5dans la mise en evidence des diplocoques Gram negatif a l'examen direct. Par contre; il etait moins sensible que le prelevement de secretions uretrales dans la mise en evidence des uretrites microscopiques (sensibilite de 44;4et specificite de 100) et de la flore uretrale d'accompagnement (sensibilite de 59et specificite de 96;9). Les bonnes performances du premier jet d'urines dans la mise en evidence microscopique des diplocoques Gram negatif pourraient justifier son utilisation dans la detection deNeisseria gonorrhoeae dans un laboratoire de niveau 1. Il pourrait egalement etre utilise dans les etudes epidemiologiques et dans les enquetes de depistage a grande echelle

[Assessment of biological sampling's quality in a medical laboratory: case of Côte d' Ivoire Institute Pasteur]. / Evaluation de la qualite des prelevements de patients ambulatoires dans un laboratoire de bacteriologie medicale : cas de l'Institut Pasteur de Cote d'Ivoire.

BACKGROUND: Assurance quality is important in medical laboratory, but in Africa, few laboratories are involved in this process. The aim of this study was to assess biological sampling's quality in a bacteriological laboratory. MATERIAL AND METHODS: A cross sectional study was undertaken in medical bacteriological laboratory of Côte d' Ivoire Institute Pasteur during 6 months. All urines, saddles, and bronchial expectorations collected from ambulatory patients during this period were included in the study. The quality of urine's, saddles and bronchial expectorations' sampling for a bacteriological analysis was evaluated. An interview based on Guidelines of good laboratories practices and referential ISO 15189 was used. A total of 300 samples were indexed. RESULTS: On a total of 300 recorded biological samples, 224 (74.7%) were not in conformity. In 87.5% of the cases of nonconformities, an antibiotic's treatment were preliminary instituted before the sampling. Corrective actions were carried in the laboratory on 30 samples with 56.6% for the urines, 26.7% for the saddles and 16.7% for the bronchial expectorations. CONCLUSION: At the end of this study, it arises that the quality of the biological sampling received at the medical bacteriology laboratory need to be improved.

[Neonatal urinary tract infections in Abidjan: the problem of bacterial resistance]. / Les infections urinaires neonatales a Abidjan: problematique de la resistance bacterienne.

BACKGROUND: Neonatal infection is frequent with rate of lethality between 20 to 70% in the developing countries. Among these neonatal infections, urinary infection is serious .The diagnosis of urinary infection is based on cytobacteriological exam. But it is rarely done for economic reasons. Principal objective of this survey was to identify the germs responsible for the urinary infections at the newborn in order to propose an adequate therapeutic algorithm. STUDY: From July to December 2004, 720 newborns hospitalized in neonatalogy for neonatal infection were enrolled. Specimens of urines were collected in view of cytobacteriological exam. Culture was positive for 136 samples (18,9%). About etiology of urinary infections, enterobacteria were predominant with 77,5% against 26,5% for cocci Gram positive. The frequency of isolation of the enterobacteria was following: Escherichia coli, Klebsiella pneumoniae, Enterobacter and Levinea with respectively 32%, 28%, 28% and 12%. The rates of global resistance of the enterobacteria to the usual antibiotics varied from 66,7% to 85,7% for the amoxicilline associated to the clavulanic acid; of 25% to 66,7% for the ceftriaxone; and of 0 to 33,3% for the amikacine.

Les infections urinaires neonatales a Abidjan : problematique de la resistance bacterienne

Les infections neonatales sont frequentes avec un taux de letalite de 20 a 70dans les pays en voie de developpement. Parmi ces infections neonatales; l'infection urinaire peut etre grave chez le nouveaune car elle met en jeu aussi bien le pronostic renal; avec l'atrophie ou l'insuffisance renale en l'absence de traitement adequat; que le pronostic vital. Le diagnostic de l'infection urinaire repose sur l'examen cytobacte-riologique des urines. Mais il est rarement effectue a cause de la pauperisation de nos populations. Le but de cette etude etait d'identifier les germes responsables des infections urinaires chez le nouveau-ne afin d'adapter le traitement. Patients et methodes : De juillet a decembre 2004; 720 nouveau-nes hospitalises en neonatalogie au service de pediatrie pour infection neonatale ont fait l'objet de prelevements d'urines en vue d'examen cytobacteriologique. Resultats La culture bacterienne a ete positive pour 136 echantillons soit 18;. Concernant les etiologies des infections urinaires; les bacilles a Gram negatif de la famille des Enterobacteriaceae etaient predominantes avec 77;5contre 26;5pour les cocci a Gram positif Streptococcus et Staphylococcus. La frequence d'isolement dans l'ordre decroissant des enterobacteries etait la suivante : Escherichia coli; Klebsiella; Enterobacter et Levinea avec respectivement 32; 28; 28et 12. Les taux de resistance globale des enterobacteries aux antibiotiques usuels variaient de 66;7a 85;7pour l'amoxicilline associee a l'acide clavulanique ; de 25a 66;7pour la ceftriaxone ; et de 0 a 33;3pour l'amikacine

Evaluation de la qualite des prelevements des patients ambulatoires dans un laboratoire de bacteriologie medicale : cas de l'Institut Pasteur de Cote d'Ivoire

L'importance de l'assurance qualite a toutes les etapes de l'analyse medicale n'est plus a demontrer; mais peu de laboratoire medical en Afrique s'engage dans ce processus. L'objectif de l'etude etait de contribuer a l'amelioration de la qualite des prelevements recus au laboratoire de bacteriologie de l'Institut Pasteur de Cote d'Ivoire. Materiel et Methodes : Une etude descriptive a ete menee dans ce laboratoire sur une periode de 6 mois. Ont ete inclus dans l'etude; tous les echantillons d'urines; de selles et d'expectorations bronchiques provenant de patients ambulatoires; recus au laboratoire de bacteriologie pendant la duree de l'etude. Les prelevements de patients hospitalises ont ete exclus. Au total; 300 echantillons ont ete repertories. Un questionnaire elabore a partir du Guide de Bonne Execution des Analyses et de la norme ISO 15189 a ete utilise pour l'evaluation de la qualite des prelevements. Resultats : Sur un total de 300 echantillons biologiques enregistres; 224 soit 74;7etaient nonconformes. Dans 87;5des cas de non-conformites; il s'agissait d'un traitement antibiotique prealable au prelevement. Des actions correctives ont ete menees au laboratoire sur 30 echantillons avec 56;6pour les urines; 26;7pour les selles et 16;7pour les expectorations bronchiques. Conclusion : Au terme de cette etude; il ressort que la qualite des prelevements recus au laboratoire de bacteriologie medicale est a ameliorer

[Benign lymphoid pseudotumors of the nasal cavity and HIV infections]. / Les pseudotumeurs lymphocytaires benignes du cavum et infections a VIH.

OBJECTIVE: To return particular aspects of the benign lymphoid pseudotumor of the cavum. MATERIAL AND METHOD: It is about a prospective survey on 7 years achieved in the ENT services of university hospital of Treichville (1994-1995) and of Bouaké (1996-2001). Five cases have been kept. RESULTS: There were 4 women and 1 man aged between 26 years and 47 years. The main reason of consultation was the hypoacousia and the nasal obstruction. A cavum tumor was founded will all the patients during cavoscopy. The tympanometry confirmed the diagnosis of otitis media with effusion. The histological operative piece exam noted a lymphoid hyperplasia. HIV serology was positive in 4 cases and negative in 1 case. The treatment consisted in surgical removal of the tumor in 1 case and in 4 cases it was associated with the grommet insertion. Three of the 4 HIV-positive patients received antiviral treatment. The evolution was good with all the patients. CONCLUSION: The lymphoid pseudotumors of the cavum must make search for a VIH infection at the young.

[Evolution of Streptococcus pneumoniae antibiotic resistance in Abidjan: update on nasopharyngeal carriage, from 1997 to 2001]. / Evolution de la résistance de Streptococcus pneumoniae aux antibiotiques à Abidjan: enquêtes de portage nasopharyngé de 1997 à 2001.

UNLABELLED: The emerging antibiotic resistance and worldwide diffusion of Streptococcus pneumoniae strains is an important public health problem. OBJECTIVES: The aims of this study were to study the evolution of S. pneumoniae resistance rates to penicillin G and other antimicrobials from nasopharyngeal carriage. METHOD: Four hundred and eighty-two nasopharyngeal samples of S. pneumoniae were studied from 1997 to 2001. The Kirby-Bauer technique was used to screen the susceptibility of samples and completed with the determination of penicillin G minimal inhibitory concentration using the E-test. RESULTS: Resistance to penicillin increased from 1997 to 2001: 8.5% in 1997, 20.7% in 1998, 16% in 1999, and 23.5% in 2001. However, the resistance to other beta-lactam antibiotics was low. The rate of resistance to cotrimoxazole increased from 52.2% in 1997 to 84.3% in 2001, with a higher degree of resistance in 2001. The resistance of S. pneumoniae to tetracycline increased. In contrast, the prevalence of erythromycin-resistant pneumococcal samples decreased from 11.6% in 1997 to 8% in 2001. The resistance to three or more antibiotics (multi-drug resistant) was also increased from 9.4% in 1997 to 23.5% in 2001. CONCLUSION: This data shows that carriage of antibiotic-resistant pneumococci is increasing in Abidjan. It will be interesting to assess the current bacterial resistance patterns by a national epidemiological observatory.

[Detection of transfusion transmitted virus (TTV) DNA in sera among three different population groups in Abidjan, Côte d'Ivoire in 2001]. / Détection de l'ADN du virus transmis par la transfusion (VTT) dans le sérum de trois populations différentes à Abidjan, Côte d'Ivoire, en 2001.

The aim of this study was to determine the transfusion transmitted Virus (TTV) prevalence in three groups of population from Abidjan, Côte d'Ivoire. The A group contained 39 multitransfused patients, the B group contained 10 blood donors supposed to be healthy persons which have never been transfused and the group C contained 43 patients with chronic liver pathology. In this last group, 33 patients had HBV positive serology and the 10 others, HCV positive serology. We used PCR to investigate TTV in patients serum. Detection rates were comprised between 67% and 82%. This is the first study to provide information about the high portage of TTV in ivorian population.

Evaluation de la mortalite maternelle de causes obstetricales directes et de la qualite d'urgence au CHU de Cocody : etude sur 3 ans (2000 a 2002)

Etude retrospective descriptive transversale et exhaustive deroule a la clinique Gynecologique et Obstetrique du CHU de Cocody (Abidjan) sur une periode de 3 ans allant du 1er janvier 200 au 31 decembre 2002. L'objectif general est de contribuer a l'effort de reduction de la mortalite maternelle a la maternite du CHU de Cocody. RESULTATS: Le nombre du personnel est suffisant pour les taches devolues a l'hopital ; -Les medicaments d'urgence bien repertories connaissent de nombreuses ruptures de stocks ; -Le sang n'est pas toujours disponible au CHU de Cocody ; -Les infrastructures sont insuffisantes ; -Les equipements sont insuffisants; la plupart sont non fonctionnels ; -Le taux des complications obstetricales directes sur l'ensemble des admissions est de 28;3pour cent ; -Le taux de cesarienne est de 28pour cent ; -Le delai median entre une indication de cesarienne et l'intervention chirurgicale est de 3 h 58 mn ; -Les hemorragies pre ou post partum representent 34;8pour cent des deces maternels suivi des avortements provoques ou septiques 23;2pour cent; puis des pre eclampsies ou eclampsies 17;7pour cent ; -Le taux de letalite global ou taux de mortalite chez les cas est passe de 3pour cent en 2000 a 2;3pour cent en 2001 et 2002. La seule salle de l'operation d'urgence; les kits de medicament souvent incomplets et le pre-paiement des couts des actes ne permettent pas de faire face a temps au grand nombre des urgences. Pour ameliorer la qualite des soins d'urgence dans le service et reduire la mortalite maternelle; nous avons fait des recommandation en fonction des problemes

Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae in healthy carriers: report of a study in 5-year-olds in Marcory, Abidjan, Côte d'Ivoire.

The increasing prevalence of antibiotic-resistant Streptococcus pneumoniae is of growing public health concern. The aim of this study was to assess resistance rates of S. pneumoniae to penicillin and other antimicrobial agents. Between November 1997 and February 1998 in a community health centre in Marcory, an Abidjan suburb, 138 S. pneumoniae strains were isolated from the nasopharynxes of 218 apparently healthy children aged 3-60 months. The sensitivity of the isolates was tested using the Kirby-Bauer method. In isolates with a possibly abnormal sensitivity to the Kirby-Bauer test, minimum inhibitory concentrations (MIC) were estimated using the E-test. Antimicrobials tested included penicillin G, amoxycillin, cefotaxime, cotrimoxazole, tetracycline, chloramphenicol, erythromycin, rifampicin and vancomycin. Twelve of 108 isolates (8.7%) had reduced sensitivity to penicillin G, and in three of them the MIC for penicillin reached at least 2 micrograms/ml. Resistance to amoxycillin and cefotaxime was lower than to penicillin (2.2%). With regard to cotrimoxazole, 37% were moderately resistant and 15.2% highly resistant. The lowest resistance rate observed was to rifampicin (2.2%) and the highest was to tetracycline (57.2%). Rates of resistance to erythromycin and chloramphenicol were 11.6% and 2.9%. All strains were sensitive to vancomycin. Multidrug resistance (MDR) was detected in 9.4% of S. pneumoniae isolates. In children, epidemiological surveillance of resistance can be monitored by bacteriological surveys, as shown in this study.

Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire: a randomised trial.

BACKGROUND: In Africa, the risk of mother-to-child transmission of HIV-1 infection is high. Short-course perinatal oral zidovudine might decrease the rate of transmission. We assessed the safety and efficacy of such a regimen among HIV-1-seropositive breastfeeding women in Abidjan, Côte d'Ivoire. METHODS: From April, 1996, to February, 1998, all consenting, eligible HIV-1-seropositive pregnant women attending a public antenatal clinic in Abidjan were enrolled at 36 weeks' gestation and randomly assigned placebo or zidovudine (300 mg tablets), one tablet twice daily until the onset of labour, one tablet at onset of labour, and one tablet every 3 h until delivery. We used HIV-1-DNA PCR to test the infection status of babies at birth, 4 weeks, and 3 months. We stopped the study on Feb 18, 1998, when efficacy results were available from a study in Bangkok, Thailand, in which the same regimen was used in a non-breastfeeding population. FINDINGS: 280 women were enrolled (140 in each group). The median duration of the prenatal drug regimen was 27 days (range 1-80) and the median duration of labour was 7.5 h. Treatment was well tolerated with no withdrawals because of adverse events. All babies were breastfed. Among babies with known infection status at age 3 months, 30 (26.1%) of 115 babies in the placebo group and 19 (16.5%) of 115 in the zidovudine group were identified as HIV-1 infected. The estimated risk of HIV-1 transmission in the placebo and zidovudine groups were 21.7% and 12.2% (p=0.05) at 4 weeks, and 24.9% and 15.7% (p=0.07) at 3 months. Efficacy was 44% (95% CI -1 to 69) at age 4 weeks and 37% (-5 to 63) at 3 months. INTERPRETATION: Short-course oral zidovudine was safe, well tolerated, and decreased mother-to-child transmission of HIV-1 at age 3 months. Substantial efforts will be needed to ensure successful widespread implementation of such a regimen.